Saturday, January 30, 2010

Jay Mercer's efforts to get more of his patients to undergo cancer screening are starting to pay off: Early detection resulted in one woman having her cervical cancer cured and gave another high hopes for recovering from a breast tumour.

The screening push is also paying off, literally, for the Ottawa family physician. His preventive campaign is partly driven by a little-known recent trend in the Canadian health-care system: incentive payments, or bonuses, paid to doctors to encourage better health care.

If he pushes a set percentage of patients through cancer screening, Dr. Mercer is rewarded with a sizeable annual bonus.

Ontario doctors can also earn bonuses of up to $5,000 for visiting patients at home; specialists in Nova Scotia receive thousands of dollars extra a year to simply stay in a rural location; and GPs in British Columbia are paid $2,100 annually just to keep delivering babies.

There are also bonuses for convincing people to have flu shots, better treating high blood pressure and merely taking on patients who have gone without a family doctor.

Such payments -- which come on top of regular fees for performing specific services -- have proven costly and controversial in the U.K., where they were pioneered. Doctors in some of the four provinces experimenting with the concept here, however, insist bonuses are already reshaping Canadian medicine for the better.

"This stuff works," Dr. Mercer said. "What these incentives do is translate into better outcomes. You've got the funding to do the extra work ... to start chasing down the [patients] who don't come in."

British Columbia introduced its incentives in part to convince doctors to operate full-service family practices with rosters of patients attached to them, rather than gravitate to the production-line -- but more lucrative -- medicine of walk-in clinics.

In just a couple of years, the bonuses appear to have stemmed the exodus from family medicine, says Dr. Brian Brodie, president of the B.C. Medical Association.

"In 2006, before these incentives started to roll out, it was so bad. People were leaving the hospitals, they were leaving family practices. It was dead, dead," he said. "[But] that conversation is done ... There's been a huge difference."

Patients whose doctors received the incentive payments -- designed partly to encourage better treatment of chronic diseases such as hypertension and diabetes -- also cost the medicare system less money, according to a report released last year by a consultant working for the province and the medical association. The theory is that they were less likely to need pricey hospital care.

The Hollander Analytical Services report was not all positive, however. A survey found that patients whose doctors claimed incentive payments were no more satisfied overall than those whose doctors did not.

The idea -- sometimes called pay for performance or quality-based incentive payment -- began appearing in other jurisdictions in the mid-2000s, a response to the pressures of a sicker, aging population, and evidence of inappropriate use of medical care.